Healthcare Provider Details

I. General information

NPI: 1679816813
Provider Name (Legal Business Name): RACHEL CREA LUCAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 N. MOORLAND ROAD URGENT CARE CLINIC
NEW BERLIN WI
53151-7494
US

IV. Provider business mailing address

300 CASSIDY AVE
LEXINGTON KY
40502-2503
US

V. Phone/Fax

Practice location:
  • Phone: 262-432-7599
  • Fax: 262-432-7694
Mailing address:
  • Phone: 952-412-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number05259
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number63288-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: